Wither AIDS, TB and Malaria: Snapshots of Africa’s Progress

The annual number of people newly infected with HIV in Africa has been reduced by 25% since 2001. From 2009 to 2012 new HIV infections among children have been reduced by 38% in the ‘Global Plan’ priority countries and access to treatment remains low for children––only 3 in 10 children in need of treatment have access in most of the ‘Global Plan’ priority countries. The number of people who died from AIDS-related causes was 32% lower in 2011 than in 2005.

Various countries are developing more robust, inclusive, results-focused national strategies and related investment cases. The Pharmaceutical Manufacturing Plan for Africa Business Plan, an African-wide framework for increasing pharmaceutical capacity, has been developed and approved and will be supported through a consortium that is now being set up.

AIDS Watch Africa, an advocacy platform for African Heads of State on AIDS, TB and Malaria set up in 2001, has been reinvigorated in the past year, as African leaders recognized the need for accelerated momentum towards meeting the targets of Millennium Development Goal 6 by 2015 and for leadership beyond to fulfil their commitments to the Roadmap. All Member States of the African Union are now members of AIDS Watch Africa.

Progress in reducing Malaria deaths and cases has been substantial

In the course of the last decade, the global effort to control and eliminate malaria expanded significantly. As a result of a scale-up of control interventions – including an expansion of access to long-lasting insecticidal nets, indoor residual spraying programmes, diagnostic testing and quality-assured treatment – more than a million lives have been saved. Malaria mortality rates decreased by 33% in Africa between 2000 and 2010. What Africa will need to do- maintain high-levels of coverage with malaria interventions, strengthen malaria surveillance and response systems, prevent drug and insecticide resistance and engage sectors outside of health.

We are at a critical time in the fight against TB

In the last 13 years, critical progress has been made in the development of new tools, and in identifying the right approaches to fight the disease. TB is curable and can be defeated, but there are three challenges that underpin the TB emergency. The emergence of drug-resistant TB, which can cost up to 100 times more to treat in comparison to drug-sensitive TB, makes timely investments more critical. Domestic financing for TB in Africa is low. On average, African governments contribute 30% of their national TB budgets, whereas in the rest of the world governments contribute 70% on average . This makes many African governments highly dependent on external financing – and extremely vulnerable to any international aid fluctuations. 88% of external donor financing for TB is from one source: the Global Fund. This provides US$ 440 million each year for the fight against TB globally. However, most of this money is not going into Africa. For every $100 going to Sub-Saharan Africa from the Global Fund, only 6% is for TB. This small amount still represents half of Africa’s available TB funding (54%). Much greater ambition is needed in terms of providing diagnosis and access to treatment for all TB patients in most African countries. It is time for an emergency response. This need for scale-up should be reflected in ambitious national strategic plans, aiming at universal coverage and zero-TB related deaths.

Health Financing

Member states of the African Union are on average still far from meeting key health financing targets of the Abuja Declaration. In 2010, only 5 countries reached the target of allocating at least 15% of their annual budget to health. Twenty eight countries out of fifty spent the minimum of US$ 44 per capita as estimated by the High Level Task Force on Innovative Financing for Health Systems (HLTF).Only three countries in Africa reached the targets set in both the Abuja Declaration and the HLTF report. Out-of-pocket payments (OOP) still represent more than 20% of total health expenditure (THE) in 40 countries in Africa. A key challenge for member states and their partners is to ensure effective and efficient use of available international and domestic resources, improved predictability, alignment to national priorities and use of government mechanisms. The reinforced dialogue between Ministers of Health and Finance, as spelt out in the Tunis forum organized by Harmonization for Health in Africa in 2012, has shown increased engagement towards financing for health and improving the effectiveness of available resources.